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BMC Internal Medicine
Welcome to BMC IM's very own wiki page: made by residents ''for ''residents. Why do we have a wiki? Amidst the bombardment of emails and segregated pod schedules, it's difficult to communicate with each other. The purpose of this wiki is to create an''' accessible space that residents can easily edit to 1) maintain effective communication and 2) utilize as a one-stop shop resource.' '''Popular Links' *For swap form, click here . * For Intern Handbook, click here (pw=bmcmed; courtesy Dan Kirshenbaum et al.) *For Conference schedule/location this week, click here. * For Medrez, click here. * For New Innovations, click here. 'COMMITTEES' Curriculum Committee 'BMC MEDICINE WARDS' *Call and Work room locations, click here *Helpful numbers, click here *What to do when a patient dies, click here MICU #Refer to ICU handbook GERIATRICS Admitting Guidelines Click here for link. Geriatric Service Admission Guidelines (Menino), Team Cap of 16 patients, Daily admission cap of 5 patients. If the team caps at 16 patients at any point during the day, it will remain capped until 7pm, regardless of discharges. 1. Any patient in the Home Care practice or the Geriatric Ambulatory Practice whose primary care physician is a faculty member or fellow in the Section of Geriatrics. 2. Any long-term care nursing home patient whose primary care physician is a faculty member or fellow in the Section of Geriatrics. 3. Any patient at a nursing home for rehabilitation whose primary care physician is a faculty member or a fellow in the Section of Geriatrics. 4. Any patient admitted with a hip fracture whose primary care physician is a faculty member or a fellow in the Section of Geriatrics. 5. Any patient admitted with cardiac problems not requiring immediate specialist cardiac care (such as CCU, EP intervention, care of MI) whose primary care physician is a faculty member or a fellow in the Section of Geriatrics. 6. Any patient with a BMC PCP 80 years old or older, if the Geriatrics Inpatient Service is not at risk of being capped. 7. Any patient aged 70 or older without any PCP (i.e. unassigned). 8. If the patient is at a nursing home for rehabilitation and a geriatrics physician is following the patient, and the patient originally came from a PCP not affiliated with BMC, the patient should be admitted to the Geriatric Inpatient Service. 9. If the patient is at a nursing home for rehabilitation and a geriatrics physician is following the patient, but the patient was followed by a non-geriatrics BMC provider, that patient should be admitted to a general medicine team. 10. Although BU Geriatrics patients should be admitted to the Geriatrics team, there will be times when this is not possible (i.e. team is capped). If this occurs, the patient should be cared for by the team to which they were admitted. Interservice transfers are at the discretion of the Geriatrics and primary team attending, and should not be systematic. RENAL Hemodialysis # Typically 3x/wk schedule (i.e. MWF or TTS). Patients may need additional treatments per attending/fellow. # If AVF (AV fistula) or AVG (AV graft), check access daily for a thrill, bruit, signs of infection, and bleeding #* Let the fellow know ASAP if there is no thrill or bruit present #* Access issues should be first thing mentioned on rounds # Avoid PICC lines and subclavian central lines #* PICC lines ruin veins for future AVF and AVG #* Subclavian central lines commonly lead to venous stenosis and this will impact the ability to use that arm for an AVF or AVG #* Dialysis catheters should only be accessed by a dialysis nurse # Blood Draws #* Can be done in HD on dialysis days; inform the fellow # Drug Dosing #* All drugs should be assessed for renal dosing and clearance by dialysis machine # New Start Dialysis Patient needs ## AV access ##* AVF or AVG: needs a vascular or transplant surgery consult ##* Tunneled Dialysis Line: Interventional Radiology consult ##** Patients must be NPO 6 hours pre-procedure in IR ## Schedule with dialysis unit ##* Cannot be discharged home without having an assigned unit (i.e. DaVita Boston) ##* Contact social worker ASAP ##* Place PPD ##* CXR ##* HBV profile ## Upon discharge ##* No renal clinic appt is necessary for any pt on dialysis ##* Every dialysis patient has a nephrologist that rounds at their unit weekly ##* No need to discharge home on iron supplements, calcitriol, or synthetic erythropoietin unless specified by attending (they'll receive them at dialysis unit) ##* No need to discharge home on alkaline therapy (sodium bicarb, bicitra) as bicarbonate is part of dialysate ##* Some dialysis patients are on diuretics; check with fellow/attending__FORCETOC__ How do I edit the Wiki? 1. You have to be on desktop mode (not mobile) to edit. Click on the drop down menu next to the pencil at the top and click on Classic Editor. The trickiest part is figuring out what level of organization (heading/subheading) your text is. The level is denoted by the dropdown menu in Editing mode. Is it a heading (major section denoted by line underneath) or is it a subheading (numbered Subheading 1, 2, etc)? 2. Every heading and subheading will be listed as part of the Table of Contents. Much of the content that are neither headings or subheadings should be "Paragraph" level of organization because it's free text not important enough to make the outline. 3. Use '''indentations '''and '''bullets '''to keep the wiki organized. You can also create '''links '''to helpful websites. Category:Browse